Provider Credentialing Specialist II

Qualifacts•Tampa, FL

1d•Hybrid

About The Position

Qualifacts is seeking a Provider Credentialing Specialist II to support credentialing and insurance paneling for behavioral health, primary care, and medical practitioners and facilities. The role maintains compliance with regulatory and accrediting requirements, develops and sustains credentialing processes and standards, and works with company leaders and customers to complete credentialing activities and renewals on time. The specialist also advises customers, escalates credentialing risks, and provides consultations and training as requested. Candidates must work a hybrid schedule from either the Nashville or Tampa office; remote candidates will not be considered.

Requirements

Proven experience in provider credentialing and insurance paneling.
In-depth knowledge of industry standards and regulations.
Ability to investigate partners’ credentialing requirements.
Excellent communication and organizational skills.
Ability and motivation to manage concurrent projects, constituents, and priorities under tight deadlines in a dynamic environment.
Ability to build positive and effective relationships with leaders internally and externally.
Team-player approach and ability to model company values and culture.
Ensure work adheres to company mission and goals and represent the company, mission, and values well to internal and external stakeholders.

Nice To Haves

Provider Credentialing Specialist certification through NAMSS.

Responsibilities

Keep abreast of regulatory developments in behavioral health, primary care, and medical staff services.
Maintain compliance with regulatory and accrediting bodies.
Collaborate with leadership to develop and implement credentialing processes and procedures.
Credential physicians, allied health professionals, and other practitioners.
Complete insurance paneling for facilities, physicians, allied health professionals, and other practitioners.
Collect and maintain an accurate practitioner database and analyze verification information.
Collect and maintain records of licenses, credentials, and insurance contracts.
Monitor partners’ and customers’ providers’ credentials and licenses.
Work with partners and customers to advise on renewal procedures and ensure timely completion of credentialing processes.
Release information to agencies and members of the public as required by law.
Escalate identified credentialing risks to the Billing Manager and partner or customer leadership.
Develop and maintain credentialing processes and standards for the department.
Keep abreast of Joint Commission and CARF credentialing requirements and Medicare, Medicaid, and commercial payer insurance paneling requirements.
Assist with the development and operation of a customer call center.
Provide credentialing consultations and training as requested.